[血友病所致足踝部病变的外科治疗]

Zhang Linghan, Weng Xisheng, Qiu Guixing, Gao Peng, Qian Wenwei, Wang Yipeng

Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, P.R.China.

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 Feb;27(2):160-3.

OBJECTIVE

To explore perioperative management and postoperative effectiveness of hemophilia induced lesions of the foot and ankle.

METHODS

Between June 1998 and February 2012, 10 cases (12 feet) of hemophilia induced lesions of the foot and ankle were treated with surgery, including 9 cases (11 feet) of hemophilia A and 1 case (1 foot) of hemophilia B. Single foot was involved in 8 cases and both feet in 2 cases, including 3 left feet and 9 right feet. All were males, aged from 13-41 years (mean, 22.6 years). Disease duration was 5-84 months (mean, 32.2 months). Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 43.2 +/- 21.1. Short Form 36 Health Survey Scale (SF-36) score was 45.4 +/- 20.0. All patients were given clotting factors (2 000-3 500 U) for pre-experiment and clotting factors substitution therapy was performed perioperatively. Four cases (4 feet) underwent arthrodesis, and 7 cases (8 feet) underwent Achilles tendon lengthening/tendon transposition (1 patient underwent tendon lengthening on the left foot and arthrodesis on the right foot).

RESULTS

The operation time was 65-265 minutes (mean, 141.1 minutes); 1 case had 400 mL blood loss and 200 mL autogenous blood transfusion, the other cases had less than 50 mL blood loss and no blood transfusion. Wounds healed by first intention in all patients, no postoperative infection, deep vein thrombosis, or other complications occurred. All cases were followed up 6 months to 14 years and 3 months (median, 22 months). The X-ray films at last follow-up showed the patients undergoing arthrodesis obtained complete joint fusion. AOFAS scores at postoperative 6 months and last follow-up were 78.8 +/- 14.7 and 75.8 +/- 14.5, respectively; SF-36 scores were 76.6 +/- 13.1 and 75.5 +/- 13.2, respectively; and significant differences were found when compared with preoperative scores (P < 0.05), but no significant difference between postoperative 6 months and last follow-up (P > 0.05).

CONCLUSION

For patients with hemophilia induced lesions of the foot and ankle, surgical treatment could relieve foot and ankle pain and improve the function. Clotting factors pre-experiment at preoperation and substitution therapy at perioperation can reduce the risk of severe postoperative hemorrhage.

目的

探讨血友病所致足踝部病变的围手术期处理及术后疗效。

方法

1998年6月至2012年2月，对10例（12足）血友病所致足踝部病变患者行手术治疗，其中甲型血友病9例（11足），乙型血友病1例（1足）。单足病变8例，双足病变2例，包括左足3例，右足9例。均为男性，年龄13 - 41岁（平均22.6岁）。病程5 - 84个月（平均32.2个月）。术前美国足踝外科协会（AOFAS）评分为43.2±21.1。健康调查简表36（SF - 36）评分为45.4±20.0。所有患者术前均给予凝血因子（2 000 - 3 500 U）进行预实验，并在围手术期进行凝血因子替代治疗。4例（4足）行关节融合术，7例（8足）行跟腱延长/肌腱转位术（1例患者左足行肌腱延长术，右足行关节融合术）。

结果

手术时间65 - 265分钟（平均141.1分钟）；1例失血400 mL，自体输血200 mL，其余病例失血均少于50 mL，未输血。所有患者伤口均一期愈合，无术后感染、深静脉血栓形成或其他并发症发生。所有病例随访6个月至14年3个月（中位数22个月）。末次随访时X线片显示行关节融合术的患者关节获得完全融合。术后6个月及末次随访时AOFAS评分分别为78.8±14.7和75.8±14.5；SF - 36评分分别为76.6±13.1和75.5±13.2；与术前评分比较差异有统计学意义（P < 0.05），但术后6个月与末次随访比较差异无统计学意义（P > 0.05）。